ACLS Cases – Bradycardia

• Bradycardia is defined as a heart rate less than 60 beats per minute

• Bradycardia may not be a clinical problem—elite athletes often have bradycardia and are quite healthy

• Symptomatic bradycardia IS a clinical problem. It requires evaluation and treatment.

• Bradycardia starts becoming symptomatic if heart rate decreasesto less than 50 beats per minute

• Symptoms of bradycardia
  • Chest pain or discomfort
  • Lightheadedness
  • Dizziness
  • Decreased level of consciousness
  • Weakness
  • Fatigue
  • Presyncope or syncope
  • Hypotension
  • Orthostatic hypotension

• Bradycardia may be sinus bradycardia or AV heart block (heart block can cause various heart rates, not just bradycardia)

Sinus bradycardia

• Atropine (0.5 mg IV/IO) is the first line treatment (repeat up to a maximum of 3 mg total)
• Consider transcutaneous pacing
• Consider dopamine IV infusion (2-10 mcg/kg per minute)
• Consider epinephrine IV infusion (2-10 mcg/kg per minute)
• Consider cardiology consult and trans venous pacing

AV block

• Types of AV block
  • First degree
  • Second degree type I
  • Second degree type II
  • Third degree
• Consider cardiology consult
• Consider transcutaneous pacing

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